Pick-Up Request Form

Before requesting a pick-up, review these policies:

  • Only University-owned Equipment can be recycled through this program.
  • Accounting Services for Research and Sponsored Programs (ASRSP) must approve recycling of any equipment acquired using federal funds. Read more about ASRSP disposal policies.
  • Report equipment with inventory tags (or cost exceeding $5,000) to the Accounting Services Equipment Inventory Coordinator, Regi George (r-george@northwestern.edu), prior to recycling.

Name *

Department *

Address *

Campus *

Phone Number *

E-mail Address *

Quantity of all items to be picked up:
CPU Monitor
Peripherals (mouse, keyboard, speakers)
Printer Scanner
Data storage devices (hard drive, zip drive, CD, etc.)
Other

Please list these details for each item being recycled (except data storage devices). Use commas to separate items:
Equipment type
Make
Model
Serial Number

Delivery considerations:
Identify any heavy or oversized items.
Identify location considerations (no elevator, etc.)

I have complied with University Policy and have received ASRSP approval for equipment acquired using federal funds and notified Regi George of Accounting Services of any equipment being disposed of with inventory tags or cost exceeding $5,000.

Pick-up Location (if different from Department Address):

* = required

You will be sent an email confirming pick-up time and date.